Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Clinical epidemiology of inflammatory bowel disease among adults in the South Asian region: A systematic review and meta-analysis(Elsevier Ltd, 2025-01) Niriella, M.A.; Martinus, C.K.; Withanage, M.Y.; Darshika, S.; Illangasinghe, M.; Perera, H.R.; Ediriweera, D.S.; De Silva, H.J.OBJECTIVES Inflammatory bowel disease (IBD) is an emerging disease in the South Asia. We conducted a systematic review to determine the characteristics and overall prevalence of IBD among South Asian adults.DESIGN We searched the PubMed database and included descriptive, epidemiological studies with satisfactory methodological quality, reporting the epidemiology of IBD with histological confirmation. The quality of the studies was assessed using Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies. Two authors screened and extracted data independently. A random-effects meta-analysis of characteristics and overall prevalence of IBD was performed.RESULTS This review analysed data from over 9000 IBD patients from 21 studies across multiple South Asian countries. It found a higher prevalence of ulcerative colitis (UC) compared to Crohn's disease (CD) (2:1). There was a male predominance and modest familial aggregation of IBD cases. Left-sided colitis was the most common disease extent for UC. Colonic involvement was more frequent than ileal involvement for CD. The non-stricturing, non-penetrating behaviour was dominant in CD cases. Joint manifestations were commonly reported in both UC and CD. Immunomodulators, such as azathioprine, were used in a significant proportion of patients, particularly for CD. The use of biological agents like infliximab was relatively low. Surgical intervention rates were lower than in Western cohorts but higher in CD compared to UC.CONCLUSIONS This study provides an epidemiological overview of adult IBD characteristics, phenotypes, and treatment patterns in the South Asian region. There were epidemiological, clinical, phenotypic and treatment differences compared to western IBD.Item Comparison of cardiovascular risk prediction models developed using machine learning based on data from a Sri Lankan cohort with World Health Organization risk charts for predicting cardiovascular risk among Sri Lankans: a cohort study(BMJ Publishing Group Ltd, 2025-01) Mettananda, C.; Solangaarachchige, M.; Haddela , P.; Dassanayake , A.S.; Kasturiratne , A.; Wickremasinghe , A.; Kato, N.; De Silva, H.J.INTRODUCTION Models derived from non-Sri Lankan cohorts are used for cardiovascular (CV) risk stratification of Sri Lankans. OBJECTIVE To develop a CV risk prediction model using machine learning (ML) based on data from a Sri Lankan cohort followed up for 10 years, and to compare the predictions with WHO risk charts. DESIGN Cohort study. SETTING The Ragama Health Study (RHS), an ongoing, prospective, population-based cohort study of patients randomly selected from the Ragama Medical Office of Heath area, Sri Lanka, focusing on the epidemiology of non-communicable diseases, was used to develop the model. The external validation cohort included patients admitted to Colombo North Teaching Hospital (CNTH), a tertiary care hospital in Sri Lanka, from January 2019 through August 2020. PARTICIPANTS All RHS participants, aged 40-64 years in 2007, without cardiovascular disease (CVD) at baseline, who had complete data of 10-year outcome by 2017, were used for model development. Patients aged 40-74 years admitted to CNTH during the study period with incident CV events or a disease other than an acute CV event (CVE) with complete data for CVD risk calculation were used for external validation of the model. METHODS Using the follow-up data of the cohort, we developed two ML models for predicting 10-year CV risk using six conventional CV risk variables (age, gender, smoking status, systolic blood pressure, history of diabetes, and total cholesterol level) and all available variables (n=75). The ML models were derived using classification algorithms of the supervised learning technique. We compared the predictive performance of our ML models with WHO risk charts (2019, Southeast Asia) using area under the receiver operating characteristic curves (AUC-ROC) and calibration plots. We validated the 6-variable model in an external hospital-based cohort. RESULTS Of the 2596 participants in the baseline cohort, 179 incident CVEs were observed over 10 years. WHO risk charts predicted only 10 CVEs (AUC-ROC: 0.51, 95% CI 0.42 to 0.60), while the new 6-variable ML model predicted 125 CVEs (AUC-ROC: 0.72, 95% CI 0.66 to 0.78) and the 75-variable ML model predicted 124 CVEs (AUC-ROC: 0.74, 95% CI 0.68 to 0.80). Calibration results (Hosmer-Lemeshow test) for the 6-variable ML model and the WHO risk charts were χ2=12.85 (p=0.12) and χ2=15.58 (p=0.05), respectively. In the external validation cohort, the sensitivity, specificity, positive predictive value, negative predictive value, and calibration of the 6-variable ML model and the WHO risk charts, respectively, were: 70.3%, 94.9%, 87.3%, 86.6%, χ2=8.22, p=0.41 and 23.7%, 79.0%, 35.8%, 67.7%, χ2=81.94, p<0.0001. CONCLUSIONS ML-based models derived from a cohort of Sri Lankans improved the overall accuracy of CV-risk prediction compared with the WHO risk charts for this cohort of Southeast Asians.Item Splenic stiffness measurement combined with liver stiffness measurement compared with Baveno VII criteria in predicting the presence of Oesophageal and Gastric varices in patients with compensated advanced liver cell disease (cALCD)(Cureus, 2024) De Silva, A.P.; Niriella, M.A.; Nishad, N.; Jayasundara, H.; Jayasena, H.; Samarawickrama, V.T.; Ranawaka, C.; Basnayake, K.; De Silva, S.T.; De Silva, H.J.INTRODUCTION Liver stiffness measurement (LSM) using vibration-controlled transient elastography (VCTE) is being increasingly used as a screening tool to predict varices. Our aim was to test the utility of Baveno VII criteria and other combinations of LSM, platelet count (PC), and splenic stiffness measurement (SSM) to predict the presence of varices in a cohort of Sri Lankan patients with compensated advanced liver cell disease (cALCD).METHODS Consecutive patients with newly diagnosed Child-Pugh class A cALCD (non-viral, BMI<30) were recruited prospectively. They underwent gastroscopy. LSM and SSM were taken using vibration-controlled transient elastography (VCTE) (Echosens FibroScan 502 Touch; Echosens SA, Paris, France) by a single operator who was unaware of endoscopy findings. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of different Baveno VII criteria to predict the varices and different combinations of LSM, SSM, and PC were also explored.RESULTS One hundred and seventy-four individuals were recruited. The mean age was 61.4 ((95% CI: 59.7-62.8) years. A total of 110 individuals were males, and 106 had varices. Our results indicated that the three Baveno VII criteria had sensitivities of 61%, 63%, and 42%, and specificities of 79%, 77%, and 87% to predict varices. SSM>30kPa alone and in combination with LSM>15kPa had sensitivities of 81 and 75%, specificities of 72 and 83%, PPVs of 82 and 87%, NPVs of 71% and 67%, and accuracies of 78 and 78%, respectively, to predict varices.CONCLUSION Baveno VII criteria had a low sensitivity but high specificity in predicting the presence of varices. However, SSM>30kPa alone or in combination with LSM>15kPa had better sensitivity, specificity, PPV, NPV, and accuracy in predicting varices.